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� PERMIT APPLICATI4N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WP. 98201 <br /> 425-257-8510— FAX 425-257-8857—www.everettwa.org <br /> APPLICA710NS ARE ACCEPTED FROM 8 AM TO 4 PM i <br /> SITE ADDRESS ��fJ� �fr'*���� 1r1 PARCEL'!AX�.D.# P RMIT M <br /> (� " �1T VyR �lS�ol ���'��L`1�o?��4c�� ��D£s �D?U <br /> LEGAL LOTNO. BLOCH TRACT <br /> OESC <br /> OWNER AUORESS CITYIZIP PHONE <br /> [�u��� �=t�cct�Cfi���' ���t -���7aanY ��ct��tT `�S�i Zt%�`1'- c��t�� <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> l nf�ti�`� �N`��1�hr'�� ���1;-tifi ���'s z��2 -•� r�3 <br /> CONTRACTOR J, LL,11�F� (�r��:t1' ADDRESS CITYIZIP PHONE <br /> f'� VY w —� L GCl•E'�"� V <br /> ��� � � ��� tJ�,�1r , _ `j <br /> CONTR.LICENSE# ��L�L(�AUG� �j �C'�i ��''�', � L�i `^��J , <br /> O � <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> ��71.�.� ` �� y� �� �•-�, <br /> � � /\Electric _Gas+otner IF�y� E.Y.�J � G�C� <br /> WORK DESCRIPTION <br /> "C�t=��NT ���,��,.t���N�= (,2��� `��) N6w �=���t ���`: � <br /> �-��C�;l`�t�-�. Fx���, . <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C—air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> St.ower Water heater <br /> Kitchen sink 8 disposal _ Gas fireplace <br />� Dishwasher Gas range <br /> Cbthes washer Ciothes dryer <br /> Laundry tray _ Range hood <br /> � Sink(service/barlmop/etc.) _ Exhaust fan <br /> Backflow preventer _ lieat pump <br /> Unnal Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeration <br /> Grease trap _ Woodstove <br /> Roof drains Oiher <br /> Other ! <br /> _ i <br /> I <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby c�ritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces goveming this type ot work will be complied with whether specified herein or not. The granting of a permit does not presume <br /> to give au�hority to violate or cancel the provision of any other state or local law regulating construction or the perfortnance of <br /> construction. That I am authorized by the owner of this propeiry to perfortn the work for which application is made and I comply with the <br /> St te Contractors Law 18.27 RCW and 29620Q WAC. <br /> S c�. <br /> , `�:� ��>`'� � � � ��'�G��� <br /> Sig e of Owner/Contrectur/Authonzed Agent Date / <br /> i � <br /> I_ _ --- <br />